Director, Pricing & Contracting

POSITION: Director, Contracts and Pricing

The salary range for this position is between $230k and $255k

Actual salary at the time of hire may vary and may be above or below the range based on various factors, including, but not limited to, the candidate’s relevant qualifications, skills, and experience. The company also currently offers a Long-Term Incentive Plan (cash plan) of 25% base salary, annual performance bonus target of 25% base salary (subject to meeting plan requirements) and comprehensive health benefits (employer funded), unlimited vacation time and 401k plan (subject to change or modification from time to time).

POSITION SUMMARY

The director, pricing and contracting will be responsible for taking the lead in devising, implementing and managing contract development in support of national, regional payer accounts and Provider Program Agreements (PPA) based on product strategies. As part of the Market Access Department, this person will administer contractual rebates, fees and other programs and ensure customer compliance with contractual terms, conditions and obligations. This individual will also serve as a lead resource and business partner for the sales and marketing departments to communicate contracting, pricing, and customer information. Responsibilities include leading contract effectiveness efforts, related analyses and proposed strategy modifications, while complying with Sarbanes-Oxley requirements.

This role will support the broader Averitas product portfolio.

KEY RESPONSIBILITIES

Develop and execute innovative contracting options that produce and maintain appropriate brand access, data access and brand profitability across Averitas product portfolio

Manage the contract development, execution and maintenance of commercial, pharmacy and medical benefit agreements to support PBM/GPO like entities, Medicare Part D, Medicare Advantage, Medicaid, and PPA contracts

Monitor price reporting for Average Sales Price (ASP) and CMS reimbursement methodologies in support of medical benefit agreements

Monitor implications to Gross to Net (GTN) to support accurate forecasting and minimize fluctuation implications on revenue

Responsible for analytic modeling to support requests for proposals (RFP)s

Facilitate the contract negotiation process by analyzing customer contract redlines, and preparing responses for both internal discussions and external negotiations

Perform timely and accurate calculation, authorization, payment and tracking of contractual rebates, chargebacks and fees

Work with cross functional partners to measure ROI on post deal analytics

Perform all necessary tasks to establish and maintain our federal and state contracts and reporting requirements:

Adhere to federal submission deadlines and requirements

Manage the Medicaid and Medicare rebate operations, including monthly and quarterly CMS pricing compliance, internal pricing analysis, systems development and dispute resolution

Manage quarterly and annual VA pricing compliance and oversee administration of the VA Federal Supply Schedule contract including annual Public Law process

Manage any price reporting functions under state law with support from our vendors

Prepare and submit Requests for Modifications (RFMs) as necessary

Oversee the development of pricing strategies for new indications and or new products

Manage the notification process for all wholesale acquisition cost and contract pricing action changes to contracted and third-party vendors

Support the development and maintenance of policies and standard operating procedures (SOPs) for rebate management, pricing actions, etc. to ensure compliant operations

Aid in forecasting to support the accrual process for financial close in support of earnings projection objectives

Ensure all federal and state rebates, e.g., Medicaid, Coverage Gap/MDP, etc. payments are made and tracked accurately and in a timely manner

Maintain ongoing communication with the finance, legal and third-party vendor to monitor and analyze pricing and/or discounts that may affect Best Price and government price reporting calculations

QUALIFICATIONS, CAREER EXPERIENCE AND SKILLS

Qualifications

Minimum 10 years’ experience in the healthcare industry

Minimum 5 years’ experience in contract administration or operations, data analysis and interpretation; prior market access experience preferred

Strong background in contract negotiations with vendors, payers, providers, specialty pharmacies, and/or distributors

Proven experience with government pricing programs (e.g. Medicaid, Medicare, 340B, VA/DoD) and commercial (medical and pharmacy benefit) contracts

Knowledge of US pricing and reimbursement structures required

Detailed knowledge of health plans and PBM decision-making processes

Demonstrated understanding of health economics

Demonstrated ability to interact with all levels of management as well as field sales, marketing, medical affairs, regulatory and vendor partners

Ability to maintain an independent and objective perspective while developing and maintaining a strong partnership with client organizations

Ability to work with and deliver on deadlines while managing multiple projects and priorities with limited supervision

Intrinsic drive and motivation to achieve success

Career Experience

Experience with pain management and/or specialty pharmaceutical or biologic products preferred

Interpersonal experience interacting and collaborating with diverse internal and external stakeholders in an unstructured environment of mutual commitment to the organization’s vision and mission

Skills

Ability to work effectively and independently in a fast-paced, entrepreneurial environment

Ability to work cross functionally when necessary

Ability to adapt behavior in response to changing information/circumstances and remain open to new ideas

Advanced analytical skills

Strong organizational skills

Strong written and verbal presentation skills

Excellent negotiation abilities

Ability to work closely with third party vendors

Ability to participate in strategy development

Requirements

Remote position

Ability to travel to customer meetings up to 40% 

Ability to travel and attend all company-sponsored events/meetings/conferences

Ethics and Compliance

Demonstrates the highest levels of ethics, integrity and trust while acting with courage and candor

Maintains high accountability for personal actions and results and has the ability to ensure a high level of commitment to the success of the organization, peers and customers

Operates in compliance with all applicable regulations and professional standards at all times

Values and Behaviors

Live Entrepreneurship: Plan for long-term growth and build a future business predicated on innovation

Be Patient-Centric: Deliver innovation for patients and challenge themself and others to improve patient outcomes

Join Forces: Seek diverse input, collaborate across all functions and leverage resources from global partners

Act with Integrity: Apply ethical standards, encourage transparency and embrace diversity and inclusivity

Drive Performance: Create an atmosphere that nurtures teamwork to enable high performance and sustainable growth